- Deficient Knowledge Related to Inadequate knowledge about hypothyroidism and Insufficient understanding of signs and symptoms of hypothyroidism as evidenced by Verbalization of concerns and Misconceptions about hypothyroidism
- Fatigue Related to Thyroid hormone deficiency and Medications that decrease thyroid hormone as evidenced by Inability to maintain activities of daily living and Impaired concentration
- Ineffective Tissue Perfusion related to alteration in serum thyroid hormone levels and Insufficient knowledge of hypothyroidism and its management as evidenced by Cold intolerance and Decreased sweating
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: -Verbalizes poor understanding -Seeks additional information Objective data: -Inaccurate demonstration or teach-back of instructions -Inability to recall instructions -Exhibiting aggression or irritability regarding teaching follow-up -Poor adherence to recommended treatment or worsening medical condition -Avoiding eye contact or remaining silent during teaching | Deficient Knowledge Related to Inadequate knowledge about hypothyroidism and Insufficient understanding of signs and symptoms of hypothyroidism as evidenced by Verbalization of concerns and Misconceptions about hypothyroidism | Patient will be able to verbalize understanding of hypothyroidism and its signs and symptoms. Patient will be able to identify behavior and lifestyle modifications suitable for adapting to life with hypothyroidism. Patient will be able to demonstrate adherence to hypothyroidism treatment | 1. Encourage participation in developing a care plan. Patient participation engages the patient in decision-making or expressing ideas regarding various treatment modalities, which involves sharing information, emotions, and physical symptoms and receiving advice from the nurse and other healthcare team members. 2. Educate on symptoms. Patients may be unaware of symptoms related to their hypothyroidism. Educate that low hormone levels affect their metabolism and often cause increased sensitivity to cold, dry skin, joint stiffness, hair thinning, and more. 3. Discuss treatment and monitoring. Instruct the patient that if changes are observed in their symptoms that they should have their TSH levels tested. If hormone levels are low, they may need adjustments in their medication. 5. Ask the patient to teach back complications. An underactive thyroid can cause elevated cholesterol and heart disease, peripheral neuropathy, infertility, and depression. The nurse can evaluate the patient’s learning by asking the patient to teach back the education. | Patient verbalized understanding of hypothyroidism and its signs and symptoms. Patient identified behavior and lifestyle modifications suitable for adapting to life with hypothyroidism. Patient demonstrated adherence to hypothyroidism treatment |
| Subjective data: Verbalization of lack of energy Objective data: -Inability to maintain activities of daily living -Impaired concentration -Irritability -Increased physical complaints | Fatigue Related to Thyroid hormone deficiency and Medications that decrease thyroid hormone as evidenced by Inability to maintain activities of daily living and Impaired concentration | Patient will be able to verbalize an increase in energy. Patient will be able to complete ADLs and work/school responsibilities. | 1. Take medication as prescribed. Levothyroxine is effective at diminishing the symptoms of hypothyroidism. The medication should be taken at the same time each day, usually first thing in the morning before eating. 2. Plan activities. Consider scheduling more complex tasks when patients have the most energy. Advise them to pace themselves and schedule adequate time for rest and sleep. 3. Keep a sleep log. Keep a sleep journal to monitor bedtime habits, difficulty falling or staying asleep, and naps. This can help the provider monitor treatment effectiveness and recommend other interventions. 4. Recommend exercise. Exercising when feeling fatigued may seem counterproductive. Moderate exercise is still recommended and will help boost energy during the day. 5. Watch caffeine and alcohol. Caffeine products can worsen fatigue, especially if taken in the afternoon as they disrupt sleep. Excessive alcohol also disrupts quality sleep. | Patient verbalized an increase in energy. Patient completed ADLs and work/school responsibilities. |
| Subjective data: -Chest Pain -Dyspnoea -Sense of impending doom Objective data: -Arrhythmias -Capillary refill >3 seconds -Altered respiratory rate -Use of accessory muscles to breathe -Unstable blood pressure -Tachycardia or bradycardia -Cyanosis | Ineffective Tissue Perfusion related to alteration in serum thyroid hormone levels and Insufficient knowledge of hypothyroidism and its management as evidenced by Cold intolerance and Decreased sweating | Patient will maintain optimal tissue perfusion as evidenced by the following: Absence of edema Strong, palpable pulses Strong and shiny scalp hair Warm extremities Capillary refill <2 seconds | 1. Treat and prevent dry skin. Use rich, fragrance-free moisturizers on the skin. Avoid hot showers or water that can irritate the skin and cause further dryness. Consider a humidifier to moisten the air. 2. Reduce edema. Hypothyroidism can slow lymphatic drainage causing fluid retention. Instruct on reducing salt in the diet, elevating the extremities, and alleviating periorbital edema with a cool compress. 3. Refer to dermatology. More severe skin concerns, like hair loss, rashes, eczema, and hyperpigmentation, can be assessed and treated by a dermatologist. 4. Keep an even skin temperature. Suggest methods to prevent cold intolerance by using a small heater in an office or bedroom, wearing layers, soaking the hands and feet in warm water, and avoiding going outside in cold weather. | Patient maintained optimal tissue perfusion as evidenced by the following: Absence of edema Strong, palpable pulses Strong and shiny scalp hair Warm extremities Capillary refill <2 seconds |